Clopidogrel is associated with Lower Hospital Readmission Rates for Myocardial Infarction Patients at Beth Israel Deaconess Hospital- Plymouth based on Real World Evidence Study of Medicare Claims Data

---

In Clopidogrel, Myocardial Infarction

By: Sara Riascos  Apr. 11, 2022

Background:

Myocardial Infarctions are frequently associated with hospital readmission. Readmission is a hospital quality measure that reflects dimensions of quality of inpatient care and also impacts overall programs by payors such as CMS’s Star Rating Program, HRRP and Value-Based Purchasing.Clopidogrel is a blood thinner used to prevent stroke, heart attack, and other heart problem. Studies have shown that Clopidogrel could reduce all-cause mortality and the probability of recurrent myocardial infarctions.

Dexur’s analysis of Real World Evidence based on Medicare Claims data showed that the use of Clopidogrel within 7 days of hospitalization was associated with lower hospital readmission rates for Myocardial Infarction Patients at Beth Israel Deaconess Hospital- Plymouth in Plymouth, Massachusetts. Reduction in readmission rates helps hospitals improve their outcomes for various cost and quality programs. Dexur is an approved entity to perform Medicare claims data analysis, which it uses to perform quality outcomes analysis. Dexur has published several papers with Harvard Medical School on quality outcomes related topics. Dexur’s analysis of Drugs and their impact on quality outcomes, such as readmissions and mortality, are used by Hospitals, IDNs, and ACOs to implement best practices and manage Real World Evidence based risk factors.

Methods:

We conducted a retrospective study using Dexur’s analysis of Real World Evidence from Medicare Claims data, for hospitalizations at Beth Israel Deaconess Hospital- Plymouth between January 2017 to September 2019. Our methodology criteria was as follows:

1. Inclusion Criteria: Selected Medical Hospitalizations with Primary Diagnosis with Myocardial Infarction related codes (Listed in table below)
2. Stratified Selected population into cohorts
   1. Myocardial Infarction patients dispensed Clopidogrel within 7 Days of Hospitalization using Part D drugs claims database
   2. Myocardial Infarction patients not dispensed with Clopidogrel within 7 Days of Hospitalization
3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Clopidogrel was associated with lower hospital readmission rates for all Primary DRG Diagnosis Codes examined at Beth Israel Deaconess Hospital- Plymouth. For patients whose primary DRG Diagnosis was “Non-ST elevation (NSTEMI) myocardial infarction”(I214) and when Clopidogrel was used within 7 days of hospitalization, the readmission rate was 48% compared to the cohort where Clopidogrel was not used, whose readmission rate was 56.39%. The readmission odds ratio for these cohorts was 0.72. The use of Clopidogrel was associated with a 28% lower readmission rate when used within 7 days of hospitalization. The full list of studied DRG codes, readmission rates, odds ratios, confidence intervals, and percentage reduction in readmission with Clopidogrel at Beth Israel Deaconess Hospital- Plymouth is shown below.

Primary DRG Diagnosis Code	Primary DRG Diagnosis Code Description	Total Hospitalizations without Clopidogrel	Readmission Without Clopidogrel	Readmission Rate without Clopidogrel	Total Hospitalizations with Clopidogrel	Readmission with Clopidogrel	Readmission Rate with Clopidogrel	Readmission Odds Ratio	Reduction in Readmission with Clopidogrel (%)	Confidence Interval (-)	Confidence Intervals (+)
I214	Non-ST elevation (NSTEMI) myocardial infarction	305

Dexur also leveraged Medicare claims data to understand what percentage of patients hospitalized with Myocardial Infarction were not prescribed Clopidogrel within 7 days of discharge.

DRG CODE	Hospital	Hospitalizations with Myocardial Infarction	% of Hospitalizations without Clopidogrel
	Eastern Maine Medical Center	1,298	98.84%
	Mayo Clinic Hospital-Rochester	1,064	98.68%
	Beth Israel Deaconess Hospital- Plymouth	317	96.21%

​Hospitalizations with Myocardial Infarction = Above Listed DRG Codes

If figures are shared with “At Least” - this implies that the drug utilization within 7 days post hospitalization is less than 11

Conclusions:

According to analysis of Real World Evidence of Medicare Claims data, for hospitalizations between January January 2017 to September 2019, the use of Clopidogrel within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Myocardial Infarction patients at Beth Israel Deaconess Hospital- Plymouth. This analysis shows that a significant number of Patients are not dispensed Clopidogrel after Myocardial Infarction hospitalizations at Beth Israel Deaconess Hospital- Plymouth or major US Hospitals.